Industry Notes:
NPI EDITS HOLD UP MANY CLAIMS
Published on Mon May 07, 2007
Heads up: CMS will shut down UPIN registry this fall.
If your cash flow has slowed to a trickle thanks to National Provider Identifier claims hold-ups, you're in good company.
"Since the editing for NPI was implemented, we have had a large volume of claims from numerous providers that have failed, causing the claims to RTP," reports regional home health intermediary Cahaba GBA in an email message to providers.
If any NPIs submitted on the claims don't match the ones listed for that provider in the National Plan and Provider Enumeration System (NPPES), the claims return to provider with reason code 32103 (The NPI number on the claim is not present in the crosswalk file), RHHI Palmetto GBA explains on its Web site.
What to do: Home care providers that see claims with that reason code should verify that all of their NPPES data is correct, Cahaba instructs. Make sure you entered your new NPI on the claim correctly, confirm that your NPI and legacy (OSCAR) number are listed correctly in NPPES, and ensure that the following items match between NPPES and the intermediary's provider file: employer ID number, tax ID number, provider name and provider address and zip code.
Hidden trap: Even something as small as using a "St." abbreviation in one file and "Street" in the other can trigger the RTP, Cahaba warns.
Problem: Of course, checking those items is difficult if the RTP is for the referring physician's NPI.
Solution: As a temporary work-around, Palmetto advises removing the doc's NPI and using her legacy UPIN instead to resubmit. Medicare will continue to accept non-billing-provider's legacy numbers until May 2008.
Another snag: But when providers serviced by Palmetto attempted to do so, they received an RTP with error code 19201 (physician's UPIN and name must be on the claim). Palmetto has reported the problem, the RHHI says on its Web site.
Don't be surprised if you get a call from your contractor. "We are now contacting those providers with large volumes of claims in RTP for reason code 32103," Cahaba says. "When we call, you are encouraged to access your information in NPPES so that your NPPES information can be compared to what we have on your provider file."
Say goodbye: Meanwhile, you'd better hope your referring physicians get up to speed on NPIs quickly. The Centers for Medicare & Medicaid Services will stop assigning UPINs to physicians on June 29 and will shut down the UPIN registry this fall.
CMS' NPI contingency plan, which allows providers to use referring docs' UPINs until May 2008, "will not affect our plans to ... disable the CMS UPIN Registry and its 'look up' functionality on September 30, 2007" CMS warns in May 31 Transmittal No. 207 (CR 5584).
Resource: CMS will [...]
